Adjuvant radiation therapy after radical prostatectomy: when is it indicated?

Radical prostatectomy is the most commonly used treatment option in the United States for men with clinically localized prostate cancer. Up to 30% of these patients, particularly those with adverse pathological risk factors, will develop a biochemical recurrence within 10 years. Patients with a biochemical recurrence have a higher rate of local recurrence and cancer-specific mortality. Current accepted treatment options include salvage radiation therapy, hormone therapy, or a combination of both, depending on whether the disease recurrence is biochemical, local, or systemic. The role of adjuvant radiation therapy (ART) after prostatectomy in patients with adverse pathological risk factors prior to biochemical or clinical recurrence is unclear. Recent randomized trials have demonstrated that ART significantly improves multiple patient outcomes, including overall and cancer-specific survival, without major untoward effects. The evidence in support of using ART is evolving with the long-term follow-up of several long-term prospective trials. The decision to use ART should be based on the patient's pathological characteristics, clinical status, side effects, and open communication between the patient and provider.